The big question for Utah during the 2012 legislative session is: “Is Utah’s health
reform working?” Utah began a reform of the health system in 2008, but the percent of Utahns without insurance has increased since then, and Utah’s exchange has brought only about 22 small businesses (20% of the 225 businesses who buy through the exchange) into health insurance that didn’t already offer it to their employees—barely a drop in the bucket. What’s the biggest problem? Affordability. Health insurance is too expensive for Utah’s small businesses and for Utahns who buy on the individual market (including the 140,000 self-employed Utah entrepreneurs)!

Utah’s leaders need to decide how they will bring people into the private insurance market.
If they don’t want to require everyone to buy insurance then they have to make it affordable. One way to do this is to help people pay their premiums. Utah has a premium subsidy program (Utah Premium Partnership) for low income workers, and it has room for more people.

Decision Point:

Increase the eligibility for adults for UPP to 200% of the federal poverty level so more people can apply.

Utah’s Health Exchange could use some improvements and a first step is a strong consumer voice. Consumers should be added back into the advisory groups of the Exchange—they were pushed out in July and replaced by high level executives (see our October Health Matters article for more information). Every month the Utah Health Exchange director meets with the insurance companies in an Insurer Roundtable. Every month the Utah Health Exchange director meets with the Brokers that sell on the exchange in a Broker
Roundtable. Where’s the Consumer Roundtable?! Our bottom line: Utah’s Health Exchange should have a governance board that includes a majority of members that don’t have a conflict of interest with the health care industry.

Decision Points: Include consumers!

Put real consumers on the Executive Steering Committee of the Utah Health Exchange.

Create a Consumer Roundtable that meets monthly.

Require a governance board that includes a majority of members without a conflict of interest.

FEDERAL HEALTH REFORM’S GIFT TO SMALL BUSINESSES: MAKING HEALTH INSURANCE MORE AFFORDABLE

Did you know that Federal Health Reform Law, called the Affordable Care Act (ACA), helps small businesses right now? If you own a small business, you know how difficult (nearly impossible) it is to include health insurance in your budget.—and the cost of insurance continues to spiral out of control. Premiums for employer-sponsored health coverage have more than doubled over the last decade. The ACA includes many provisions to help insurance become more affordable for small businesses, including the tax credit available right now for small businesses that provide insurance for their employees. You can try out
UHPP’s “Business Group on Health’s” online tax credit calculator to see if your small business qualifies.

In addition, states will create a Small Business Health Option (SHOP) insurance market place that pools risk and purchasing power for small businesses (Utah’s Health Exchange doesn’t do this yet, and will need some tweaking to be fully federally qualified) and federal rules require that insurance companies limit the amount of your premium dollar that can go to administrative costs (known as the “Medical Loss Ratio”). For more information about how the Affordable Care Act will help your small business see the report by the Small Business Majority by clicking here. For more information and resources for small businesses visit their website www.smallbusinessmajority.org.

Tell your story: If your small business is struggling to offer health insurance or simply can’t afford to, or if your small business is benefiting from the tax credit, share your story and help UHPP work to help bring the costs of health insurance down! Call Shelly or Luis at 801-433-2299 or email at shelly@healthpolicyproject.org or (en Español) luis@healthpolicyproject.org.

The Utah Health Exchange (UHE) invites all Utahns who work for small businesses, all Utahns who buy their health insurance in the individual market, and all uninsured Utahns to the first UHE Consumer Roundtable, Friday, November 18 in the Multi-Purpose
room at the State Capitol.

Join Patty Conner, UHE Director, as she takes us through a virtual tour of the Utah
Health Exchange and presents Utah’s options for future insurance exchanges. This will be followed by a roundtable discussion to identify important consumer issues concerning Utah’s Health Exchange.Let your voice be heard!

The Department of Health invites public input on a proposed pilot program that will require a group of fewer than 100 Medicaid enrollees (actually PCN enrollees) to give service to the community in exchange for their health program benefit.

House Bill 211 (2011), sponsored by Rep. Ronda Menlove, directed UDOH to develop a pilot program and submit a waiver amendment to the Centers for Medicare and Medicaid Services (CMS). If approved [UHPP: we don’t expect this will be approved and will work directly with CMS to make sure], the amendment would allow the state to modify enrollment rules for the Primary Care Network (PCN), which will create a new eligibility group for the pilot participants. Applications will be accepted only during open enrollment periods and approved applicants will receive the same medical benefits afforded to other PCN clients.

Medicaid officials believe the service donation will help build a sense of contribution
to the program and enhance the client’s experience [UHPP will share an opposing perspective. For the meager primary care benefits that The waiver application will be available for review and comment on November 15, 2011 at http://health.utah.gov/medicaid/HB211proposal.htm.

In addition to providing comment during the public hearings, written comments will
also be accepted through December 2, 2011. Comments may be submitted to the Utah Department of Health, Division of Medicaid and Health Financing, PO Box 143102, Salt Lake City, UT 84114-3102 or to cdevashrayee@utah.gov

Monthly Meeting

(No meeting in November)

Remember that Monthly Meeting happens every other month, according to this
schedule…

December 7 (at DWS)

February 1 (at DOH)

We find Monthly Meetings are most productive when topics are generated by the community! Please email ideas for DWS topics to Gina Cornia of Utahns Against Hunger: cornia@uah.org; health topics to Jason Cooke at Utah Health Policy Project jason@healthpolicyproject.org.

GETTING TO THE UTAH STATE CAPITOL

Public Transportation: If you are downtown, the UTA bus is a great option to get up to the Hill. Route 500 will take you right to the East Building’s front door! The Capitol is in the Downtown Free Zone and buses run every 15 minutes. You will find the bus and Trax schedules, routes, and trip planner at their website: http://www.rideuta.com/

Driving from outside of Salt Lake: take I-15 (either north or south) to the 600 South exit and head east on 600 South. Turn left on State Street and head up the hill to the State Capitol.

Governance turns out to be a tricky subject in Utah when it comes to health insurance
exchanges (web-based insurance marketplaces). One way to think of how an exchange is governed has to do with where the exchange is housed. Does it belong to a state entity, like the insurance or health department, or is it a stand-alone entity—a private nonprofit organization? Today Utah’s health exchange is situated in the Office of Consumer Health Services (OCHS), which was created to house the exchange inside the Governor’s office of Economic Development (GOED). Another way to think of how an exchange is governed has to do with who makes decisions. Utah’s health exchange decision-makers seem to be Norm Thurston, the Governor’s Health Reform Implementation Coordinator Patty Conner, the Director of the Utah Health Exchange, and the Risk Adjuster Board, which consists of 3-5 actuaries from insurers who sell in the exchange, 1 individual employer or employee, 1 director from OCHS, 1 actuary from PEHP, and the Insurance Commissioner (or representative). It’s obvious the decision-making structure of the Utah Health Exchange currently is weighted heavily to the insurance industry. Where are the consumers?? See our October HealthMatters article on the recent change to the Utah Health Exchange Advisory structure.

Governance: state or independent entity?

Utah’s Health System Reform Task Force considered governance options for Utah’s Health Exchange on October 19, 2011—that is, they considered options for where the exchange could be housed. Cathy Dupont, Associate General Counsel, presented the 4 structures in the Utah Code that could serve as alternatives for future exchanges in Utah: an existing state agency, an independent state agency, an independent public corporation, or an independent quasi-public corporation. Each of these options carries rules and regulations with it. For example, Utah’s Health Exchange is currently housed in a state agency (GOED), meaning it is subject to state administrative, purchasing, and hiring rules. If Utah’s exchange were housed outside of the state, in an “independent public corporation,” federal
health reform law would require it to have a governing board, to consult with all stakeholders on a regular basis, and to ensure that decision-makers not have conflict of interest. For more information about the related issues policymakers need to address see Tim Jost’s article “Health Insurance Exchanges and The Affordable Care Act: Eight Difficult Issues.”

Specifically, state agencies are presumed to be subject to the following laws, unless otherwise exempted in statute, while independent public corporations and independent quasi-public corporations are not (for more information see Cathy Dupont’s materials by clicking the “related materials” for October’s Task Force meeting here):

Independent public corporations and
independent quasi-public corporations are subject to the Open and Public Meetings (Title 52, Chapter
4) (Meetings) and GRAMA (Title 63G, Chapter 2) (Records Management).

Governance: getting a consumer voice into the decision-making process

It is time to get the consumer voice back into the process of decision making around Utah’s health exchange (see our October HealthMatters article on the recent change to the Utah Health Exchange Advisory structure). Come to the first “UHE Consumer Roundtable” hosted by Patty Conner, UHE Director, Friday, November 18, from 8:30-10:00 at the State Capitol, Multi-Purpose room, located just inside the north entrance of Capitol (click here for a map).

If you own or work for a small business, if you buy health insurance in the individual market or forgo health insurance altogether because it is too expensive (or you’ve been turned down!) this roundtable is for you! This is your chance to be a vital part of the ongoing process of holding Utah’s Health Exchange to the stated goal of decreasing the rate of uninsured in Utah and making sure decisions about the future of health insurance in Utah reflect input from consumers.

For this first meeting, Patty Conner will take attendees through a virtual tour of the Utah Health Exchange, bringing everyone up to speed on the UHE, and discuss Utah’s next steps with Exchange 2.0. This will be followed with time to discuss issues and concerns to consumers in the small business and individual market. No RSVP is necessary, but you can contact Shelly Braun at shelly@healthpolicyproject.org or 801 433 2299 if you have any questions.

Hot off the press, UHPP just published a new fact sheet about Insurance Premium Rate Review. Beginning this month (September 1, 2011) insurance companies must publish and justify all proposed premium hikes of 10% or more for
the individual and small group markets, and state insurance departments must review them. This is part of the
nation’s health law as established by the Affordable Care Act (ACA). In order for rate review to help consumers,
Utah’s Department of Insurance (DOI) needs both the authority and resources to do so. HB128 (Rep. Dunnigan) gives our insurance department the responsibility to review rates but not the authority to do anything about non-compliant insurers. Utah accepted a $1 million federal grant last year to prepare for this new task and now have the staff needed to review 100% of all rate filings.

There’s a lot of work to yet be done to build strong consumer protection into Utah’s rate review process: Utah’s rate review process must be transparent, include a forum for public comment, and grant Utah’s DOI authority to enforce its
decisions.

If your insurance company issued you an unreasonable premium increase you can make a complaint to the Department of Insurance, either online at http://www.insurance.utah.gov/complaint/index.html or by phone 1-800-439-3805. Have you issued a complaint and are not satisfied with the outcome? Share your story with UHPP—send an email to Shelly.

The number one concern for Utah small businesses in healthcare reform is controlling costs, followed by having coverage that is guaranteed and covers everybody.

88% of Utah small businesses not offering health insurance say they can’t afford to, while 79% of those who do offer it say they are really struggling to do so.

80% of small businesses support establishing a health insurance pool to create a marketplace where small businesses and individuals choose their coverage. Only 12% oppose this proposal.

79% of small businesses want to eliminate preexisting condition rules, and 74% see these rules as a barrier to starting a business.

77% support a proposal to establish a minimum standard of coverage for health insurance benefit packages in order to facilitate comparison shopping in the marketplace, ensure access to medical care, and protect people from financial risk.

69% prefer having the choice of a private or public health insurance plan, with 20% preferring private only and 7% preferring only a public health insurance plan.

67% say it is important for individuals, employers, insurers, the government and healthcare providers to share the responsibility for making healthcare more affordable.

64% say healthcare reform is important to getting the economy back on track.

57% say their company has a responsibility to provide health coverage for its employees.

46% believe that businesses that don’t offer health insurance should be required to pay something to cover their employees, although 40% say no contribution should be required. Of those who agree a contribution should be required, more than half believe it should be less than 5% of payroll.

Utah’s health system reform is based on the principle that the market is the best mechanism for improved access to quality, cost effective health care.

That’s why the Utah Health Exchange (Utah’s key tool in state reform) is based on an “operational model,” which welcomes all insurers who meet minimum standards into the Exchange, relying on market forces to generate product offerings. The result? Currently four insurers (SelectHealth, Altius, UnitedHealthcare, and Regence BlueCross BlueShield of Utah) offer a total of over 120 plans on Utah’s Exchange. The Exchange is growing at a slow but steady pace. As of April 1, over 80 small businesses are enrolled (2,472 lives) with an additional 86 businesses at various stages in the enrollment process for the next couple of months.

Despite the upswing in interest, Utah’s Exchange is still a mixed bag for those who buy health insurance there.

The big benefit for employers who use the Exchange is that they can make a “defined contribution” towards employees’ premiums. This is a pre-determined amount of money each employee receives towards his or her insurance premium. This is different from the standard way employers contribute to their employees’ premiums: paying for a specified percent of each employee’s premium. While this makes costs easier for the employer to predict, the employees stand to lose if their premiums increase and their employer chooses not to increase the defined contribution towards the premium.

Participating employees will appreciate having more of a choice of plans when they are insured through the Exchange. No longer do they have to take the plan their employer has chosen for them, but can hand-pick a plan that best meets their needs—whether a lower cost high deductible plan with a health savings account, or a more traditional insurance plan with higher premiums and a low deductible. However, if the employee chooses a product that costs more than the defined contribution made by the employer, the employee pays the difference.

So far the Exchange has made a very small dent in Utah’s uninsured population. Just 17 of the small businesses that are buying health insurance through the Utah Health Exchange did not previously offer health insurance to their employees. This means that in terms of key reform goals like covering the uninsured, the Exchange so far falls short. And a big part of the problem is cost—Utah’s small businesses want affordable, accessible health care coverage, but the price is too high for many of them. As reported by Small Business Majority (see the full report here) in 2009:

Just 40% of Utah small business owners surveyed by the Small Business Majority reported paying for health insurance for their employees—of those, 78% say they’re really struggling to do so.

Of the 60% who don’t provide insurance, 88% say they can’t afford it.

The number one concern for Utah’s small business owners regarding healthcare reform is controlling costs, followed by having coverage that is guaranteed and covers everybody.

It’s time for Utah’s leaders and the Health System Reform Task force to get serious about addressing cost—for employers, taxpayers, and consumers. Utah’s Exchange needs affordability standards, real risk pooling, and seamless integration of eligibility screening of premium subsidies and public programs.

deliver lower prices for small businesses, the engine of Utah’s economy

create affordability standards with triggers to premium assistance programs. This is important because small business owners really care about the quality and cost of benefits for their employees.

With that background, we are as surprised as you are to learn that Joel Ario, HHS official over exchanges, feels that Utah has a “valid model” for Exchanges. Read more.

UHPP has arranged a conference call with Mr. Ario onMarch 23rd at 9:00-10:00 AM (mtn) to clarify his appraisal of Utah’s Exchanges and what his expectations will be for Utah’s Exchange moving forward. To RSVP, please send email with complete contact info to kim@healthpolicyproject.org. This conference call is closed to members of the media. SPACE WILL BE LIMITED. To participate, you must sign up by March 22, 12 noon.

Other Private Market Legislation Updates

HB404 (sponsored by Rep. Ipson) now has content. This bill requires the Retirement and Independent Entities Interim Committee to coordinate its study of health benefits for state employees with the study by Health System Reform Task Force of the operations of the Health Insurance Exchange on issues such as quality of health care, provision of health insurance to state employees, retirees, and their families, and controlling expenditures. If this legislation passes, it would potentially provide us with information valuable to the future of Utah’s own health system reform.

If you are a small business owner or employee, consider adding your name to our sign-on letter urging all Utah Legislators to support HB 128 because it strengthens Utah’s Health Exchange, the key to Utah’s market based health care system reform which began in 2008.

New and not improved: HB128 Health Reform Amendments, sponsored by Rep. Dunnigan has been re-drafted–again. It is now available to the public here.

Cultural competency training for Brokers who sell on the Exchange and real consumer representation and small business representation on the Exchange Advisory Board have been taken out of HB 128.

UHPP asked why these items were taken out of HB128…

Question: Why take out information about working with culturally diverse populations?

Answer: The Exchange training for the brokers is too long already—there’s no room for information about Utah’s diverse populations.

But over 8000 refugees have been welcomed to Utah since 2000, and more than 40 different languages spoken in Utah homes. These are the very people—Utah’s residents from all over the world –who work for Utah’s 67,000 small businesses, and information about linguistic and cultural competency will help brokers who sell on the Exchange help them navigate their health insurance choices.

Question: Why shouldn’t consumers and small business employees be represented on the Utah Health Exchange Advisory Board?

Answer: The board is too big already.

But a strong Exchange is the key to Utah’s reform of the health care system. The Utah Health Exchange staff have been charged with the task of creating a “good shopping experience” for consumers—one in which people can base their health care choices on quality information, filtered according to their health care priorities. Consumer and small business employee input—input from the very people who are using the Exchange–is vital to a strong exchange.

URGE Rep. Dunnigan to put consumers and small business owners back on the Board. Their perspective and input is very important to making Utah’s Exchange work for Utahns.

New Bills— a few new bills, numbered but not yet written, have appeared on the legislative website, and this is what we know so far:

Sneak Peak—Rep. Dougall says this bill will ask the question: “Should the State become a collection agency for unpaid emergency room bills when hospitals do not pursue payment?”

Unpaid emergency department (ED) bills are not the cause of our health care system’s problems, but a symptom of the fundamental problem that people, especially low income people, do not have health insurance. When people don’t have insurance, they delay care and often end up in the ED with costly medical problems. This bill, inasmuch as the unpaid ED bills are the result of un- and under-insured Utahns using the ED for either emergency or primary care, takes the wrong approach to reducing costly and inappropriate use of the ED. The state should focus their resources on expanding coverage, not on punitive bills collection to Utah’s hard working un- and under-insured.

This bill would repeal the Statewide Risk Adjuster slated to begin in 2013. This would not affect the Risk Adjuster now operating in the Exchange. News on the street is that this bill will not be written because the repeal is included in HB 128 (Health Reform Amendments, sponsored by Rep. Dunnigan).